HomeMy WebLinkAboutAUTH-10-2022-183003.TIF w��%fie CATAWBA COUNTY Case k AUTI-I-10-2022-183003
y -+ Public Health Department Subdivision
R „:,,;t Environmental Health Division PINti 372408982315
t, PO Box 389,25 Government Drive,Newton,NC 28658 LOIN 2
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Site Address: 4021 SULPHUR SPRINGS RD NE, HICKORY NC 28601
Name on Permit KIMBERLYN CRAIG
Property Size: Acres 0.52
Directions: Springs Rd,right onto Sulpher Springs Rd,property on the left
Owner/Authorized Representative Acknowledgement of Permit Receipt
ela certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
Iproperty described above.
As the property owner or authorized representative,I have received the above referenced
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permit(s)as requested in the application for service EHPR-10-2022-42563,by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
IElectronic Image Transmittal/E-mail (Return receipt required) ..__
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, As the property owner or authorized representative I have reviewed and understand the specific conditions
' permit issued, and further understand that all applicable regulatory requirements specified under the
North Carolina Laws and Rules for Sewage Treatment and Disposal Systems(15A NCAC 18A.1900),
and/or Well Construction Standards(15A NCAC 2C.0100), shall apply to the issuance of this permit and
the construction of the wastewater system and/or water supply well permitted.
Permit Issue Date: 10/26/2022
Owner/Authorized Representative Signature I rYl h 5 , cro,r
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` Date -1 1 d.v
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature j Date/Time jo00)
Method: Fax / Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
We wantt tto hear from youPlease ttake a few momentts tto complette our custtomer service survey aft
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olryxantil 10/26/2022 09:22 12-r